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New mammography guidelines have Kitsap health officials outraged

Dr. Michael Cook, medical director at Advanced Medical Imaging, reviews a digital mammogram. New guidelines raising the recommended age for mammograms to age 50 have angered many in the local health community.

— image credit: Courtesy photo

Barb McAllister knew something wasn’t quite right.

When she was 51 years old, she told her doctor of suspicions she had had following one of her monthly self-examinations for breast cancer. Though the doctor didn’t see anything, McAllister was already approaching her scheduled annual mammogram screening.

Though no form of cancer appeared in the mammogram, McAllister was referred to a sonogram, which showed a microscopic form of cancer.

The doctor told her not to worry.

“I wasn’t comfortable with that,” McAllister said.

The Bainbridge Island resident proceeded to ask her family practitioner about the symptoms, who referred her to a surgeon.

The surgeon took a look after the cancer. After three different forms of surgery, McAllister’s life was saved.

“I think it’s really important to do routine self-examinations from a young age,” she said. “I found my own cancer and it saved me life. Women need to take the responsibility and do the self-examinations.”

On Nov. 16, the government-appointed U.S. Preventive Services Task Force released new guidelines for breast cancer. The task force came out against self- or physician breast examinations. It also opposed routine screening mammograms for women ages 40 to 49 or over 75, as well as advocated biannual instead of annual screening for women ages 50-74.

“My first reaction what that I was scared for other people,” McAllister said. “I would like everyone to have the options for screening. From everything I’ve read, and from what I’ve experienced, people are getting cancer at a younger age.”

The task force said many of these early screenings were unnecessary and led to false alarms, causing anxiety for the patients.

Advanced Medical Imaging, Kitsap County’s largest provider of mammography screenings, has no plans to follow any of the new guidelines.

“There is universal outrage,” said Kurt Newcomer, administrator for AMI. “Most people believe it’s politically motivated. No insurance company as far as I know adapted the guidelines.”

The American College of Radiology came out strongly against the guidelines, highlighting the 30 percent drop in the breast cancer mortality rate since regular mammography screening began in 1990. Kathleen Sebelius, secretary of health and human services, and the American Cancer Society, among others, also have came out in opposition.

In 2008, there were 49 patients diagnosed for breast cancer younger than age 50 at AMI in Kitsap County. Of that number, 34 of those cases were first suspected through self-examinations. The other 15 were found through routine screening.

Newcomer, whose sister-in-law died of breast cancer prior to the age of 40, said he did not see the cost benefits of reduced procedures as comparable to cost of a potential human life.

“It’s a death sentence to these people to tell them not to get screened,” he said.

Newcomer added he had never heard of the group prior to the announced guidelines.

“They are not experts on mammography,” he said. “I don’t know what to think of that committee.”

The guidelines hit personally for Kristen Gavern, an employee at AMI. The mother of one of her close friends was diagnosed at age 48. If she hadn’t been screened, then the cancer would have spread within the next six months.

“He said, ‘My mom would have been dead without the screening,’” she said.

Manfred Henne, a radiologist with In Health Imaging, said the recommendations were largely made to reduce costs by lowering the number of excessive tests, or defensive medicine. Henne said this policy is the wrong way to go about tort reform.

“The policy is largely financial driven,” he said. “With younger women, there is still a reasonable chance of cancer.”

AMI radiologist Christian Ericksen described mammography for the younger women as one of the most important elements of the past few decades in the evolution of health care.

“We are finding out earlier. The death rate is decreasing because of early detection,” she said. “It is almost like they’re not trying to find cancer early.”

She also strongly opposed the recommendation for 50- to 75-year-olds to switch from annual to biannual screenings, highlighting the differing speeds that different forms of breast cancer can emerge.

Gavern said the new guidelines are already producing negative impacts.

“When they put out things in the media that aren’t fully understood, it confuses women,” Gavern said. “All the other studies say we are doing a good job saving lives.”

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